早產兒使用靜脈營養相關的膽汁鬱積：危險因子與預測因子

Parenteral Nutrition-associated Cholestasis in Premature Babies: Risk Factors and Predictors

謝孟翰(Meng-Han Hsieh)

指導教授 ： 楊生湳

高雄醫學大學/醫學院/醫學研究所/碩士(2011年)

https://doi.org/10.6832/KMU.2011.00051

摘要

背景:
嬰兒使用靜脈營養治療下常見的併發症是靜脈營養相關的膽汁鬱積。膽汁鬱積發生的原因被認為是多重原因的。本研究的目的是評估我們新生兒加護病房發生膽汁鬱積的危險因子，並找出有用的預測因子。
方法:
本研究為一回溯性分析，我們收集了從2004年1月到2007 年1月住進新生兒加護病房、懷孕週數小於36週，且靜脈營養治療至少2個星期的早產兒。靜脈營養相關之膽汁鬱積定義為在靜脈營養治療期間出現直接膽紅素大於1.5mg/dl。
結果:
這個研究包含62個嬰兒，其中11個嬰兒(17.74%)發現有靜脈營養相關的膽汁鬱積。懷孕週數、出生體重、靜脈營養時間、敗血症次數以及第2和第3週平均攝取的能量，統計結果發現在膽汁鬱積和非膽汁鬱積的嬰兒中有顯著的不同。而靜脈營養時間是其中最顯著的危險因子。
結論:
在我們的研究中，低懷孕週數、低出生體重、反覆敗血症和長時間靜脈營養是膽汁鬱積的危險因子。而第2和第3週攝取較低熱量可以是靜脈營養有關的膽汁鬱積的預測因子。

關鍵字

膽汁鬱積 ； 靜脈營養 ； 早產兒

並列摘要

Background
One of the most common complications in infants under parenteral nutrition treatment is parenteral nutrition-associated cholestasis (PNAC). The etiology of PNAC is thought to be multifactorial. The aims of this study were to evaluate the risk factors of PNAC in our neonatal intensive care unit (NICU) and endeavor to determine useful predictors.
Methods:
From Jan. 2004 to Jan. 2007, we enrolled premature infants (gestational age <36weeks) admitted to our NICU with parenteral nutrition infusion for at least 2 weeks. Multiple possible risk factors were analyzed by a retrospective review study design. PNAC was defined as direct bilirubin greater than 1.5 mg/dl during the course of parenteral nutrition.
Results:
There were 62 premature infants with prolonged course of parenteral nutrition in this study, and 11(17.74%) of them developed PNAC. There were significant differences in gestational age, birth body weight, duration of parenteral nutrition, septic episodes, and the second and third weeks’ average energy intake between cholestasis and non-cholestasis infants. Among these risk factors, duration of parenteral nutrition was most significant after multivariate logistic regression analysis.
Conclusion:
Low gestational age, low birth body weight, more sepsis episodes and long parenteral nutrition duration were the significant risk factors of PNAC in our study. Low energy intake during the second and third weeks of life can be a predictor of PNAC.

並列關鍵字

cholestasis ； parenteral nutrition ； premature

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